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General NPI Number Information
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NPI Number | 1811008683
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ASSESSMENT CENTER, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 6625 MIAMI LAKES DR E EXECUTIVE SUITE 328
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2708
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Country | US
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Telephone | 305-779-8565
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Fax | 954-430-6742
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Provider Business Mailing Address
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Address Line | 6625 MIAMI LAKES DR E EXECUTIVE SUITE 328
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2708
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Country | US
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Telephone | 305-779-8565
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Fax | 954-430-6742
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/PRESIDENT
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Name | DR. TANIA DIAZ
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Credential | PSY.D.
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Telephone | 305-779-8565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY 7316
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6296
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License Number State | FL
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